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Telogen Effluvium

Telogen effluvium is characterized by abnormal thinning or hair loss in early years of life. It is a type of scalp disorder, which primarily occurs due to early onset of the telogen phase.


Presentation

Increased shedding of hair is the most common clinical sign of telogen effluvium. Hair scalp would feel less dense than it was before. Hair loss does not follow a distinct pattern and affects the entire region of scalp equally.

In the acute form of telogen effluvium, hair loss occurs for less than 6 months. Affected individuals notice sudden loss of hair. In the chronic form, hair loss continues for more than 6 months. The onset is gradual, but it can get difficult to identify the inciting factors [6].

Malaise
  • […] out of the hair is known scientifically as Telogen Effluvium, a condition found mostly among those who have under gone some physical change such as a trauma, a diet (crash diets specifically) or are at the moment undergoing some form of psychological malaise[hishairclinic.com]
Alopecia
  • Diffuse alopecia is mainly caused by telogen effluvium, diffuse androgenetic alopecia (female-pattern hair loss) and diffuse alopecia areata. Differential diagnosis between the three disorders may be difficult in several occasions.[ncbi.nlm.nih.gov]
  • "Clinical and histological challenge in the differential diagnosis of diffuse alopecia: Female androgenetic alopecia, telogen effluvium and alopecia areata - part II". Anais brasileiros de dermatologia . 87 (6): 884–890. PMID 23197208 .[en.wikipedia.org]
  • Diffuse androgenetic alopecia (female pattern hair loss), telogen effluvium, and diffuse alopecia areata may have similar clinical manifestations.[ncbi.nlm.nih.gov]
  • The aim of this study was to assess QoL in patients (n 104) with alopecia areata, telogen effluvium, and androgenic alopecia, and to compare QoL with hair loss severity (HLS) as independently rated by both patient and dermatologist.[ncbi.nlm.nih.gov]
  • The administration of zinc for zinc deficiency-related alopecia may recover appropriate activities of metalloenzymes, hedgehog signaling, and immunomodulation, all of which are required for normal control of hair growth cycle.[ncbi.nlm.nih.gov]
Confusion
  • Chronic telogen effluvium (CTE), a poorly understood condition, can be confused with or may be a prodrome to female pattern hair loss (FPHL). The pathogenesis of both is related to follicle cycle shortening and possibly to blood supply changes.[ncbi.nlm.nih.gov]
  • Chronic telogen effluvium may easily be confused with female pattern hair loss and a correct diagnosis is essential as there are possible treatment options.[lucindaellery-hairloss.com]
  • Chronic Telogen Effluvium is sometimes confused with female pattern hair loss, so it is important to receive the correct diagnosis to explore the various treatment options.[lucindaellery-hairloss.co.uk]
  • Always consult your GP, Dermatoligist or Trichologist if there is a sudden unexplained hair loss, they will give you a considered diagnosis, as chronic Telogen Effluvium can easily be confused with Female Pattern Baldness.[hairlossnetwork.co.uk]
  • An area of confusion concerning the diagnosis of telogen effluvium is the fact that making the diagnosis does not necessarily lead to an understanding of its cause in a particular patient.[nahrs.org.tempdomain.com]
Paresthesia
  • Trichodynia refers to pain, discomfort, and/or paresthesia in the skin of the scalp or the hair. There may be an associated psychologic comorbidity.[ncbi.nlm.nih.gov]
  • Rebora et al. [ 22 ] originally proposed the term ‘trichodynia' for discomfort, pain, or paresthesia of the scalp related to the complaint of hair loss, and found a frequency of 34.2% of female patients who had their hair consultation because of hair[karger.com]
Excitement
  • However the culmination of research in the field of hair biology and the burgeoning field of chronobiology may lead to exciting breakthroughs in our understanding of CTE.[ncbi.nlm.nih.gov]

Workup

Laboratory tests are of little help in diagnosing the condition of telogen effluvium. In view of this, scalp biopsy is the one of the most useful methods to diagnose the condition. However, this test is also seldom necessary if history of the disease is characteristic and gentle pull produces numerous hairs. For the pull test approximately 20 to 60 hairs are firmly, but not forcefully, tugged away from the scalp. Telogen hairs will have a characteristic appearance [7].

In addition, blood tests would also be required to determine the underlying etiology. Complete blood profile, serum iron, ferritin and iron saturation are all warranted to evaluate the presence of iron deficiency. Medical practitioners regard iron saturation as a more valuable test for confirming iron deficiency [8].

Human Papillomavirus
  • We describe two cases of telogen effluvium occurring in two 11-year-old children following bivalent human papillomavirus (HPV) vaccine administration. The two children began to lose their hair following the second HPV vaccine dose.[ncbi.nlm.nih.gov]
  • ( 25611604 ) Goodman E.J. 2013 33 Clinical severity does not reliably predict quality of life in women with alopecia areata, telogen effluvium, or androgenic alopecia. ( 21601948 ) Reid E.E....Wickless H. 2012 34 Telogen effluvium following bivalent human[malacards.org]
Lymphocytic Infiltrate
  • infiltrate in alopecia totalis. [6] Vitamin D levels may also play a role in normal hair cycle. [7] See also [ edit ] Anagen effluvium Noncicatricial alopecia References [ edit ] a b Marks, James G; Miller, Jeffery (2006).[en.wikipedia.org]

Treatment

Treating the underlying etiology can help in effective management of the condition. Individuals with a poor diet are advised to consume a nutritionally balanced diet in order to correct deficiencies if any. If telogen effluvium occurs as a side effect of certain medications, then the same should be withdrawn and substitute advised [9].

Chronic telogen effluvium does not resolve spontaneously and can lead to baldness in certain cases. Individuals are given topical minoxidil which has proven to be helpful in many instances. Affected individuals often chose hair transplantation for restoring the lost hair; its efficacy has however not been proved.

A well balanced diet should be consumed. Those in practice of taking large doses of Vitamin A should be discontinued.

Prognosis

The prognosis of telogen effluvium is pretty favorable with hair loss arrested and new growth initiated with prompt treatment regime. The condition usually gets corrected within 6 – 9 months. However, in chronic cases, it may take longer than usual time for recovery to occur.

Etiology

Factors that significantly disrupt the normal hair cycle call for development of telogen effluvium. Some form of stress forcibly causes the roots of hair to enter the telogen phase prematurely. The various factors responsible include several eating disorders, hormonal imbalances, surgery, and physical trauma, deficiency of iron, certain medications, weight loss and changes in dietary pattern. Other factors that contribute to more than normal hair loss include, severe infections, conditions of hypothyroidism and hyperthyroidism, high fever and psychological stress [2].

Epidemiology

Telogen effluvium is a common phenomenon, and majority of individuals have experienced it, at least once in their lifetime. The exact incidence however is not known. No mortality has been associated with telogen effluvium. Morbidity profile is limited only to mild cosmetic alterations. The condition can strike any individual at any age. Infants are at lesser risk for developing telogen effluvium. Telogen effluvium has a predilection for women between the age group of 30 to 60 years [3].

Sex distribution
Age distribution

Pathophysiology

Telogen effluvium causes significant loss of hair from all parts of the body, however hair loss from the scalp is the more evident. Pathophysiology of telogen effluvium is greatly influenced by the hair growth cycle. The hair cycle follows distinct phases:

  • Anagen (growth phase)
  • Catagen (short transition stage)
  • Telogen (resting phase)

Anagen occurs for for 2 to 7 years and is genetically determined. The catagen phase is short and signals the end of the active growth of a hair. The resting phase takes between 1 to 6 months. During the telogen, the hair continues to remain in the follicle, until it is removed by growth of new hair [4]. In majority of individuals, 5 – 15% of scalp hair is always in the telogen phase. Trigger factors such as stress, physical trauma, medications and or surgery can cause the hair to prematurely enter the telogen phase. Shedding however does not occur until new hair grows in the follicle [5].

Prevention

Not all factors can be controlled to prevent hair loss. However, dietary modifications and withdrawing certain medications can help in arresting telogen effluvium. Improving iron stores and normalizing levels of serum iron can also help prevent hair shedding [10].

Summary

Telogen phase is defined as the resting stage of the hair follicles. Alterations in the normal cycle of the hair can lead to considerable hair loss. Telogen effluvium can be both acute and chronic in nature. It is more of a reactive process which is triggered by hormonal factors or conditions that induce psychological stress. With prompt initiation of treatment and if the disease is in its initial stages, recovery is spontaneous. If there is a family history of alopecia, then complete recovery may take time [1].

Patient Information

  • Definition: Telogen effluvium is characterized by excessive hair loss which causes gradual thinning of hair. Middle aged women are more prone to develop the condition than males. Infants in early months of life are less likely to suffer from telogen effluvium.
  • Cause: Several factors can trigger the onset of telogen effluvium which include physical trauma, psychological stress, iron deficiency, changes in dietary pattern, and side effects to certain medications, high fever, illnesses, infections, weight loss and surgical procedures.
  • Symptoms: Excessive hair fall is the preliminary and major sign of telogen effluvium. Individuals may notice less dense hair in scalp. More than normal hair would be noticed on pillows, bathrooms and hair brush.
  • Diagnosis: Laboratory tests are of little value in diagnosing telogen effluvium. However, complete blood profile, serum iron levels, ferritin level and iron saturation studies are required for understanding the etiology. Scalp biopsy may be required in certain instances. In addition, a hair pull test would also be done to determine telogen effluvium. Hair strands having characteristic white bulb at the end is an indication of telogen effluvium.
  • Treatment: Chronic form of telogen effluvium does not resolve spontaneously. Surgery to restore hairs is not much effective. Topical application of minoxidil lotion may be applied and has found be effective in arresting hair loss.

References

Article

  1. Headington JT. Telogen effluvium.New concepts and review. Arch Dermatol. Mar 1993;129(3):356-63.
  2. Olsen EA, Reed KB, Cacchio PB, Caudill L. Iron deficiency in female pattern hair loss, chronic telogen effluvium, and control groups. J Am AcadDermatol 2010; 63:991.
  3. Whiting DA. Chronic telogen effluvium: increased scalp hair shedding in middle-aged women. J Am AcadDermatol 1996; 35:899.
  4. Paus R, Cotsarelis G. The biology of hair follicles. N Engl J Med 1999; 341:491.
  5. Sinclair R. Chronic telogen effluvium: a study of 5 patients over 7 years. J Am AcadDermatol 2005; 52:12.
  6. Hadshiew IM, Foitzik K, Arck PC, Paus R. Burden of hair loss: stress and the underestimated psychosocial impact of telogen effluvium and androgenetic alopecia. J Invest Dermatol 2004; 123:455.
  7. Hillmann K, Blume-Peytavi U. Diagnosis of hair disorders.SeminCutan Med Surg 2009; 28:33.
  8. Rasheed H, Mahgoub D, Hegazy R, et al. Serum ferritin and vitamin d in female hair loss: do they play a role? Skin PharmacolPhysiol 2013; 26:101
  9. Price VH. Treatment of hair loss. N Engl J Med 1999; 341:964.
  10. Trost LB, Bergfeld WF, Calogeras E. The diagnosis and treatment of iron deficiency and its potential relationship to hair loss. J Am AcadDermatol 2006; 54:824.

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Last updated: 2018-06-22 07:14